Obamacare: How do we like it now?

Chapter 1

Then and now

DENVER — Jamel Brown and Matt Wright, healthy and in their 30s, declare they'd rather pay a penalty than premiums for health insurance. Catherine Huston tells them they're nuts.

"What if you get cancer?" the 57-year-old woman demands. "Maybe it's because I'm older, but I just can't believe people think they aren't going to need it." Her job as a dispatcher doesn't include coverage, and she was reduced to tears of frustration when glitches and delays stymied her efforts to enroll in Medicaid.

Six months ago, USA TODAY brought together 10 uninsured Coloradans in the Mile High City to discuss what they thought about the Affordable Care Act as the law's first enrollment period was about to open. A few hours before the March 31 midnight deadline when enrollment would close, six of those participants and five additional people in similar circumstances gathered over soft drinks in a conference room at KUSA-TV to discuss what they had done about it.

Their stories reflect the promise and the problems of the biggest expansion of health care in America in a half-century. Four are delighted and relieved to finally have health insurance. Three made at least some efforts to sign up but found the process too complicated or confusing to complete. And the final four decided they'd rather take their chances and pay the fine.

USA TODAY Washington Bureau Chief Susan Page met with Coloradans before and after the Affordable Care Act rolled out to hear their experience with President Obama's signature legislation.

Their experiences, now and down the road, will help determine whether the program known to just about everyone as Obamacare ultimately is judged a success or a failure.

"It's a great start and something we need," says Carol Bergschneider, who signed up for insurance that began on the first day possible, Jan. 1, ending years of struggle to get the insulin she needs to manage her diabetes.

Wright isn't convinced, at least not yet. "It sure sounds good — with a big 'maybe' and a medium-sized 'but,' " he says.

Connect for Health Colorado reports that nearly 280,000 state residents gained coverage during the six-month enrollment period, including 120,971 who signed up for private insurance plans as of Monday and 158,521 who enrolled in the expanded Medicaid program as of April 1. In an interview last fall, Patty Fontneau, CEO of the non-profit organization running the exchange, had estimated that 125,000 to 140,000 Coloradans would sign up for insurance through the exchange during its first year.

Colorado, where Barack Obama was nominated for president in 2008, vowing to overhaul the health care system, seems to be an apt place to take the law's measure. With the support of Democratic Gov. John Hickenlooper, it is one of 16 states, plus the District of Columbia, that set up its own exchange under the Affordable Care Act. A swing state in presidential elections, it is a place where national political forces from the Tea Party movement to the growth in Latino voters play important roles.

A statewide poll taken by USA TODAY and Princeton Survey Research Associates found that Coloradans, insured and uninsured, have learned more about the law during the past six months but don't like it any better. Nearly three of four say they understand its impact on them and their families, at least somewhat. Six in 10 have seen TV ads sponsored by Connect for Health Colorado.

Negative views of the law have barely budged. Six months ago, Coloradans disapproved of the law by 52%-33%. Now their disapproval stands at 53%-37%. Opponents continue to be twice as likely as supporters to say they feel very strongly.

The latest survey by land-line and cellphone of 701 Colorado residents was taken March 20-24. The previous poll of 704 Coloradans was taken Sept. 11-16, 2013. Each has a margin of error of +/-4 percentage points.

One significant shift: Coloradans apparently are concluding the law is here to stay. Last fall, by 17 percentage points (54%-37%), those surveyed said elected officials who disapproved of the law should do what they could to make it fail. Now, by 10 points (50%-40%), they say officials should do what they can to make the law work.

"It's going to need adjustments as it goes," acknowledges Amy Kitteringham, 48, who was surprised to discover when she went on the Colorado website that she was eligible for Medicaid, at least until she can land a job. That meant she could see her doctor for a long-delayed checkup. "All the bugs aren't worked out, and it's not communicated well," she says of the act, but she calls it "a step in the right direction."

She hasn't been able to persuade her son, in his late 20s, to sign up.

Chapter 2

Dangerous demography

The demographic divide in attitudes toward the law could be its biggest challenge.

Three of the people around the table have pre-existing medical conditions that made it difficult for them to buy insurance in the past; all have signed up for coverage. Five of the people around the table are younger than 40 years old; four of them haven't signed up. None of the four men in the group has enrolled.

That's a potential problem. To keep premiums affordable and the system afloat, it needs to attract a fair share of the younger and healthier people who are likely to need the least medical care, as well as those older and sicker ones who are likely to need the most. In Colorado, 26% of those who signed up were young adults, 18 to 35 years old. Nearly half, 46%, were 45 to 65.

To Wright, 31, the generational trade-off doesn't seem entirely fair. "It's like a scale to me: What return do I get for my money?" he says. He doesn't begrudge paying for child care for his 5-year-old daughter, who has health insurance through her mother, and he sees the need for car insurance because he's on the road a lot for his job in real estate.

But after spending a half-hour on the Colorado website, he calculated that coverage would cost him $150 to $200 a month, while the penalty for the first year wasn't likely to exceed $500. He decided to save his money and take his chances. "For me, knowing my family, my history, what I eat and what I do, it's led me to wait," he says, though it does mean putting off treatment for a bum shoulder.

In the poll, young adults under 30 are less likely to approve of the law than the middle-aged, those 30 to 64, though they're also less likely to disapprove of it.

The starkest divide, not surprisingly, is along partisan lines. Three of four Democrats approve of the law. Nine of 10 Republicans disapprove. Though independents were more divided, they disapprove of it 56%-34%.

Coloradans remain unconvinced the law will help them. Nearly half say they are very concerned the Affordable Care Act will end up costing them more money, and more than a third are very concerned it will reduce the quality of their health care.

"The idea for me is that if everyone is on board, then it is affordable and we can all see doctors," Wright says. "I think it could also be a saturation issue where the care actually goes down in value because the doctors potentially are seeing twice as many people — maybe longer wait times, shorter time with the doctors. I don't know."

Most of those surveyed say the health law hasn't had much of an effect on them and their families. Of those who have seen an impact, by 26%-14%, they say it has been mostly negative rather than mostly positive. In coming years, by 40%-25%, they predict it will have a negative effect on them personally.

Expectations are more dire for the country as a whole, presumably reflecting the drumbeat of opposition and the problems with the rollout of the HealthCare.gov website. A 51% majority say the law has been bad for the nation and predict it will have a negative effect over the long term.

The first open-enrollment period has closed, but the debate isn't over. In the Colorado Senate race, the leading Republican contender, Rep. Cory Gardner, hammers incumbent Democrat Mark Udall for his support of the Affordable Care Act. Obama carried Colorado in 2008 and 2012, but his popularity in the state has declined since then. In recent weeks, the conservative group Americans for Prosperity aired nearly $1 million in TV ads attacking Udall and warning, "Obamacare doesn't work."

At the roundtable, Brown, 35, a security guard, labels the Affordable Care Act "extortion" because of its mandate that he has to buy coverage or pay a fine.

When asked to describe the law in a word or phrase, Catherine Campbell pauses and finally says, "Conflicting."

Huston: "Something we all need, but I don't know if we can all afford it."

Alan Libertone: "Just put a question mark there."

Rebecca Hardy: "A good idea."

Janette Cilleffen: "Confusing."

Lynette Langlois: "Relief."

Chapter 3

Changing views

For those who joined the roundtable discussion last fall and again this spring, some of the quick takes reflect big changes in views of the law.

Six months ago, Bergschneider expressed skepticism that the law could work, saying she'd rather pay more taxes than deal with a complicated new system. Now she calls it "a great start" and expresses delight that, with health care coverage, she has been able to get an insulin pump to help control her diabetes.

Campbell's view of the law is still ambivalent — "conflicting" — but her comment six months earlier was that she was worried she couldn't afford it. She has signed up for medical and dental coverage through her employer at about $40 a week. "It's doable, so I was pretty shocked," she says.

Last fall, asked to describe the law in a word, Langlois had said, "Expense."

Like most of those around the table, she encountered problems when she tried to sign up. The 57-year-old stay-at-home mom has diabetes, and for years, she couldn't buy insurance. Eager for coverage, she and her husband went on the state website only to find themselves flummoxed.

They finally scheduled an appointment with a system "coordinator" at a library, brought along paperwork showing their income and walked out an hour later with health insurance coverage for the first time in five years. Her husband was so excited he planted a kiss on the cheek of the woman who had helped them navigate the system. The word she uses to describe the law is "relief."

Lynette Langlois, 57, a stay-at-home mom, has diabetes. She signed up for coverage that began last month. “It actually makes me feel better to know that I can go anytime I need and have good health care through a physician and not just take aspirins at home,” she says. (Photo: Nathan Armes for USA TODAY)

Jamel Brown, 35, a security guard, decided to pay the penalty for not being insured. “I’d like to get a whole, complete physical," he says, "but I don’t smoke. I don’t do drugs. I’m just an average guy – try to work out here and there. I don’t get hurt, you know, at least not yet. So I’m OK.” (Photo: Nathan Armes for USA TODAY)

Catherine Huston, 57, dispatcher for emergency maintenance at apartment complexes. She tried unsuccessfully to sign up for Medicaid: “I don’t understand how it works and there’s no place to go for answers, because all you do is wait on the phone.” (Photo: Nathan Armes for USA TODAY)

Catherine Campbell, 27, a records manager, enrolled in coverage as of Jan. 1 through a new employer. “I thought ... I wasn’t going to be able to afford (it)," she says, "but it’s actually doable, so I was pretty shocked.” (Photo: Nathan Armes for USA TODAY)

Amy Kitteringham, 48, is between jobs. She enrolled in Medicaid last month. “I went and saw my doctor. I hadn’t seen him in a year," she says. "He was actually really happy I had coverage, and he said, ‘Let’s get some blood work done and have some tests.’” (Photo: Nathan Armes for USA TODAY)

Matt Wright, 32, a real estate agent, decided to pay the penalty for not being insured. “The only thing I’ve got is a bad shoulder," he says, "so as long as I don’t push it too hard in volleyball, I’ll be OK. ... I think if it was a hip or some other body part, you know, things might be different, right?” (Photo: Nathan Armes for USA TODAY)

Barry Roake, 48, a freelance writer and artist, hasn’t signed up. “I have never had health insurance because I haven’t really needed it," he says, "but I am getting to the age where it’s starting to concern me a little bit. I would love to have it, but it just seems like it’s too far out of reach.” (Photo: Nathan Armes for USA TODAY)

Carol Bergschneider, 56, office contract worker. She had been unemployed and was enrolled in Medicaid as of Jan. 1, though she has just gotten a new job and expects to move to a private plan. “I’m diabetic. (Now) I get all of that insulin for three months for $80. That’s almost $1,000 worth of insulin for $80 with the plan here ... and I have a new insulin pump.” (Photo: Nathan Armes for USA TODAY)

Janette Cilleffen, 37, a part-time house/office cleaner, hasn’t signed up but would like to get on Medicaid. “It’s not been high on my priority list and ... we just haven’t gotten a lot of information on it,” she says. (Photo: Nathan Armes for USA TODAY)

Alan Libertone, 36, a warehouse worker, hasn’t signed up. “It’s not a priority at this point to go shell out a bunch of money for something I’m not going to use,” he says. (Photo: Nathan Armes for USA TODAY)

Rebecca Hardy, 49, unemployed.
She went on the exchange website once, encountered problems and gave up. She isn’t concerned about the law’s mandate that she have insurance coverage. “I don’t think people are taking it really all that seriously. All of the political media, the commercials and, you know, just back-talking back-and-forth (saying), ‘This isn’t going to work’ ... That’s what you hear, (that) it’s not working and it’s not going to work.” (Photo: Nathan Armes for USA TODAY)

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In the USA TODAY surveys, the percentage of Coloradans who said they were covered by health insurance rose a tick during the sign-up period, to 86% from 83%, a change within the margin of error.

Problems with the enrollment process and confusion about the law color views. It's one reason some of the repeat participants, including Wright and Libertone, have no more positive view of the law than they did six months ago.

Kitteringham struggled to deal with the troubled federal website until a story on Colorado Public Radio made her realize there was a state website she was supposed to be using instead.

"They did a horrible job of letting people know about it, honestly," she says as heads nod around the table. "When elections are happening, people come to your door, everything's on television all the time, you're getting stuff in the mail constantly. But yet this is coming out, and it was kind of random places where this information came."

Huston spent two hours waiting to get through by phone the first time, then an hour and 45 minutes the second. Both times, the system rejected her application for Medicaid although she says she falls within the guidelines for eligibility. She was told she could buy coverage for $137.50 a month, an amount she says is more than she can afford.

Cilleffen, 37, waited until the last day to go on the website. "I tried to get on this morning, and it was completely down," she says. "My mom is freaking out about it. She wants me to do it as soon as I leave here," before the midnight deadline.

Then there's Libertone, who works three part-time jobs, none of which offer health coverage. During the evening, he expresses astonishment at what he's hearing. "Clear this up: This is some sort of deadline about getting signed up?" he asks, raising his arms in surprise and exasperation. "I thought it was Jan. 1."

He hadn't met that deadline, he says. Will he meet this one? Probably not, he says.